| NPI | 1851382477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M8454) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 75151) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: MA 75151) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2016-06-16 |