NPI | 1154958619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61667687) |
Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 69507) |
208VP0000X (Licence: MN 69507) | |
Enumeration Date | 2020-03-25 |
Last Update Date | 2025-07-23 |