| NPI | 1124550132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0090521) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301112096) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-08-02 |