| NPI | 1730562364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 72272) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 272226) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 61043) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2024-01-31 |