| NPI | 1235492315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301101357) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: MI 5315082409) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2020-11-02 |