| NPI | 1699913178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA bb5078654-as-143-an) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA bb5078654-as143-an) |
| Enumeration Date | 2009-01-22 |
| Last Update Date | 2011-04-22 |