| NPI | 1326215823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 245855) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2009-00594) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 64670) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2023-10-25 |