| NPI | 1629049275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 71525) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: AZ 71525) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2025-10-17 |