| NPI | 1578357760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 83108) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: MN 35104) |
| Enumeration Date | 2025-04-04 |
| Last Update Date | 2026-07-23 |