| NPI | 1194165050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 63938) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2017-00765) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MO 2013020088) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-07-21 |