| NPI | 1356699433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: TN MD0000040649) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: VA 0101244335) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |