| NPI | 1225009566 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 39144) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 39144) | 
| Enumeration Date | 2006-01-26 | 
| Last Update Date | 2020-08-04 |