| NPI | 1790749646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD029145E) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: DE C1-0006716) |
| Enumeration Date | 2006-04-15 |
| Last Update Date | 2013-08-01 |