| NPI | 1356658389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NC 2011-01487) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 33814) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2015-03-09 |