| NPI | 1669883351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 28830) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME124935) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2019-05-23 |