| NPI | 1609815695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME55718) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: FL ME55718) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME55718) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME55718) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2009-05-08 |