| NPI | 1487738928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 15874) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OK 15874) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2018-07-14 |