| NPI | 1659570331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA OS005840L) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL OS6729) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2025-03-30 |