| NPI | 1568405934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 66967) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A157791) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2020-09-29 |