| NPI | 1962646067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: CT CT033304) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT ct033304) |
| 207L00000X Anesthesiology (Licence: CT 033304) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2013-08-29 |