| NPI | 1457527772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: ID M-11061) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: ID 7257910-1205) |
| 207L00000X Anesthesiology (Licence: KY R1476) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2010-08-05 |