| NPI | 1104169390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 63762) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 62895-20) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2018-11-06 |