| NPI | 1487881124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX P9653) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10034008) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2017-12-18 |