| NPI | 1821245424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME108567) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301088532) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2025-06-25 |