| NPI | 1376683672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M9386) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D0065872) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M9386) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-06-23 |