| NPI | 1336585090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2018020857) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 58102) |
| 207L00000X Anesthesiology (Licence: IL 125.070800) | |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2018-07-30 |