| NPI | 1730392093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 067446) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD AS385293924) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2012-08-27 |