| NPI | 1396364808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX V8305) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 69598) |
| 207R00000X Internal Medicine (Licence: MN 30839) | |
| Enumeration Date | 2020-04-14 |
| Last Update Date | 2025-09-02 |