| NPI | 1912292152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC MD93647) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA MD43396) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2025-04-02 |