| NPI | 1649616459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX q4477) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX q4477) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2025-09-15 |