| NPI | 1962794206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 55606) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 106347) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 65916) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2024-12-17 |