| NPI | 1770787905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MI 5101017279) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101017279) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2019-04-04 |