| NPI | 1174057970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 64743) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101026090) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2022-11-08 |