| NPI | 1790840320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 38099) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A94246) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A94246) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2023-03-07 |