| NPI | 1386935500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 60120) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 57414-20) |
| 207R00000X Internal Medicine (Licence: NH 15555) | |
| 207R00000X Internal Medicine (Licence: ME 018923) | |
| 207R00000X Internal Medicine (Licence: VA 0101249917) | |
| 207R00000X Internal Medicine (Licence: WI 57414-20) | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2016-01-09 |