| NPI | 1386623502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MI 4301406392) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301406392) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2023-05-23 |