| NPI | 1851655914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX S9793) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA L-251375) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-03-10 |