| NPI | 1619084738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 3429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 3429) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-08-20 |