| NPI | 1215290143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 1215290143) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-9536) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2022-07-21 |