| NPI | 1205248754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 65331) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 6197 - 851) |
| 208800000X Urology (Licence: IA R-09946) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2020-06-29 |