| NPI | 1407340771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WY 15773A) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT215921) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2023-08-16 |