| NPI | 1548245939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PR 12238) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 12238) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2018-11-01 |