| NPI | 1447479548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 29296) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: CO 29296) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2012-10-10 |