| NPI | 1508162207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 83261) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: NC 2014-01594) |
| 207R00000X Internal Medicine (Licence: NC 2014-01594) | |
| 207L00000X Anesthesiology (Licence: NC 2014-01594) | |
| 207L00000X Anesthesiology (Licence: MN 68555) | |
| 207R00000X Internal Medicine (Licence: WI 83261) | |
| Enumeration Date | 2011-01-28 |
| Last Update Date | 2026-09-03 |