| NPI | 1710930938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M3253) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M3253) |
| 174400000X Specialist (Licence: TX M3253) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2016-04-12 |