| NPI | 1518960012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 32312) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 107063) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-01-30 |