| NPI | 1467413567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX J7879) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX J7879) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2019-11-04 |