| NPI | 1558789990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301506923) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301508669) |
| 207L00000X Anesthesiology (Licence: OH 35.134914) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2024-02-01 |