| NPI | 1366795080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO CDRH.0058899) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO CDRH.0058899) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2026-07-02 |