| NPI | 1427092592 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208VP0000X  (Licence: NM A-964-99)  | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NM A-964-99)  | 
| Enumeration Date | 2006-06-16 | 
| Last Update Date | 2013-07-18 |