| NPI | 1588736714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX H8149) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX H8149) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2014-04-01 |