| NPI | 1679865513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS003901L) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: PA OS003901L) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: PA OS003901L) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2023-03-07 |