| NPI | 1356685150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 77120-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 29163) |
| 207L00000X Anesthesiology (Licence: MN 66406) | |
| 207R00000X Internal Medicine (Licence: MN 29163) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2022-09-01 |