| NPI | 1285677393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 32845) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 30549) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-06-02 |