| NPI | 1588623920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 26261) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 01923) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 01923) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 26261) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2024-01-15 |