| NPI | 1700149648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 55829) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC LL34886) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2018-06-01 |