| NPI | 1447228507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: VA 0102206162) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MB07691800) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2020-07-16 |