| NPI | 1871612424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: ME 013163) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 58117) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-09 |