| NPI | 1639110125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME68242) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME68242) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-11-30 |