| NPI | 1942629316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS019392) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA OS019392) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2021-07-12 |