| NPI | 1336242445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 49967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO T2006018415) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-07-22 |