| NPI | 1710393970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35C.003363) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301105804) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 68860-20) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35C.003363) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2026-02-05 |