| NPI | 1558590992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 54160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 21866) |
| 207R00000X Internal Medicine (Licence: MN 54160) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2017-04-18 |