| NPI | 1679916126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NV 21221) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 10210153-1205) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2023-08-25 |