| NPI | 1679983811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC MD82938) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2019-02605) |
| 207L00000X Anesthesiology (Licence: SC MD82938) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2019-02605) | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2022-02-24 |