| NPI | 1508395690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 91421) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 91421) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 287445) | |
| 207R00000X Internal Medicine (Licence: MA 271963) | |
| 207L00000X Anesthesiology (Licence: MA 271963) | |
| 207L00000X Anesthesiology (Licence: MA 287445) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2024-02-01 |