| NPI | 1306378393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 64368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL41069) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-11-01 |