| NPI | 1811330764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX R3592) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 269573) |
| 207L00000X Anesthesiology (Licence: TX R3592) | |
| 207L00000X Anesthesiology (Licence: TX bp10046236) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2026-01-29 |