| NPI | 1346273208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: MT 77074) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD032407E) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-01-15 |