| NPI | 1659683886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301097217) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301097217) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2020-12-10 |