| NPI | 1861559627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology Addiction Medicine (Licence: OR MD18059) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: OR MD18059) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-01-29 |