| NPI | 1770896763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 33581) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 33581) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 84746) | |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2026-07-14 |