| NPI | 1801174800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101281347) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX Q5856) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2026-07-01 |