| NPI | 1477678019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: CA A46369) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CA A46369) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A46369) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |