| NPI | 1164695979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 81944) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL me125114) |
| Enumeration Date | 2008-04-12 |
| Last Update Date | 2026-04-28 |