| NPI | 1477750362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 55544) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 51189) |
| 207L00000X Anesthesiology (Licence: WI NONE) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2020-12-07 |