| NPI | 1427065739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY TL#1520) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WY TL#1520) |
| 207L00000X Anesthesiology (Licence: MO 2006018422) | |
| 207L00000X Anesthesiology (Licence: MT 11837) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2012-10-12 |