| NPI | 1376982496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD60834293) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60834293) |
| 207L00000X Anesthesiology (Licence: MA 270493) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2018-11-01 |