| NPI | 1902824378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 20364) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 20364) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-02-24 |