| NPI | 1164519955 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 46093) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 46093) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-01-30 |