| NPI | 1962473264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME64562) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME64562) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME64562) | |
| 202K00000X (Licence: FL ME64562) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2012-09-26 |