| NPI | 1730138728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS7822) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J2013) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: FL OS7822) | |
| 207L00000X Anesthesiology (Licence: CO DR.0049896) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2015-11-19 |