| NPI | 1952665317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 266397) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252587) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 266397) | |
| Enumeration Date | 2012-07-01 |
| Last Update Date | 2016-12-14 |