| NPI | 1134329766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301090394) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY C1092) |
| 207L00000X Anesthesiology (Licence: WV 32217) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301090394) | |
| Enumeration Date | 2007-07-22 |
| Last Update Date | 2024-11-14 |