| NPI | 1811316490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 55654) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 55654) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-06-06 |