| NPI | 1306816707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN MD47242) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 43520) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2012-08-13 |