| NPI | 1659337343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101234526) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101234526) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2018-04-17 |