| NPI | 1679658736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 32246) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 32246) |
| 207L00000X Anesthesiology (Licence: CA A94601) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2017-06-21 |