| NPI | 1053413625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 60263) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 47201-020) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-12-04 |