| NPI | 1689105678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TX T3771) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX T3771) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-09-06 |