| NPI | 1497011662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MT 58707) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD175480) |
| 207L00000X Anesthesiology (Licence: MN 107069) | |
| 207L00000X Anesthesiology (Licence: MN 57116) | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2022-07-21 |