| NPI | 1992148720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101272514) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 85223) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2025-03-13 |