| NPI | 1891955498 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA 440136) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 232286) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 095085) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2011-05-31 |