| NPI | 1801871637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 19501) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: AL 19501) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2013-01-15 |