| NPI | 1972879856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2015-01019) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NC 2015-01019) |
| Enumeration Date | 2012-03-26 |
| Last Update Date | 2015-07-31 |