| NPI | 1396739736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 29892) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 29892) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VT 042-0008748) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2013-03-13 |