| NPI | 1710393970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 68860-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301105804) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-06-20 |