| NPI | 1053999144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 72059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 31664) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-08-25 |