| NPI | 1063947075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020020966) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 28962) |
| 207L00000X Anesthesiology (Licence: MN 64293) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2023-06-30 |