| NPI | 1770036410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC MMD.39925.LL) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 39925) |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2023-02-22 |