| NPI | 1639135601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME86102) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 228247-1) |
| 207L00000X Anesthesiology (Licence: FL ME86102) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2019-01-09 |