| NPI | 1861818957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR DO227861) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NH 23225) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2026-01-22 |