| NPI | 1891950119 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 2013018937) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 264340-1) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2020-11-09 |