| NPI | 1962564476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AL AL 13577) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 40660) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2023-02-16 |