| NPI | 1124400593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MN 66498) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 264050) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-10-16 |