| NPI | 1508144296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 335720) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: LA 335720) |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2023-07-17 |