| NPI | 1407316300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD70007684) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD70007684) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-12-10 |