| NPI | 1053114603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 83112) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: MN 35102) |
| Enumeration Date | 2025-03-29 |
| Last Update Date | 2026-07-28 |