| NPI | 1548204548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 21188) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 14382R) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-08-01 |