| NPI | 1558479352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA G82005) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 10347) |
| 207L00000X Anesthesiology (Licence: CA G82005) | |
| 207L00000X Anesthesiology (Licence: MI 4301079245) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2014-05-30 |