| NPI | 1063700706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME127666) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2011019291) |
| 207L00000X Anesthesiology (Licence: MN 61737) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2020-09-01 |