| NPI | 1407843790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME74689) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: FL ME74689) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME74689) | |
| Enumeration Date | 2005-10-01 |
| Last Update Date | 2017-12-21 |