| NPI | 1356526693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 63083) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 201502495) |
| 207L00000X Anesthesiology (Licence: NE 26198) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA C143795) | |
| 207R00000X Internal Medicine (Licence: NE 5689) | |
| Enumeration Date | 2008-01-06 |
| Last Update Date | 2018-06-13 |