| NPI | 1609894476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 24155) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 18140) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2017-10-24 |