| NPI | 1104015551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 61228) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MS T-2038) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2022-12-07 |