| NPI | 1508081787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 5101016025) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 4747) |
| 207L00000X Anesthesiology (Licence: OK 4747) | |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2015-02-18 |