| NPI | 1992980718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME146540) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME146540) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: LA MD.203414) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MS MD24110) | |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2020-10-09 |