| NPI | 1780915736 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD025169E) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA G41823) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2010-01-14 |