| NPI | 1720117518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: DC MD21027) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DC MD21027) |
| 208D00000X General Practice (Licence: DC MD21027) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: DC MD21027) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |