| NPI | 1811917750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD27813) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A94417) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 45911) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2012-12-31 |