| NPI | 1255328498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301111345) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME93927) |
| 207L00000X Anesthesiology (Licence: WI 23002) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME93927) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2018-03-17 |