| NPI | 1225028020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301503103) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 20666) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35078000) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-12-17 |