| NPI | 1578557336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD023729E) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD023729E) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: PA MD023729E) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2017-12-08 |