| NPI | 1578976965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NV 18835) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 18835) |
| 207R00000X Internal Medicine (Licence: MA 259917) | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2022-02-25 |