| NPI | 1861846479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME136676) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S5568) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME136676) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-03-21 |