| NPI | 1649413543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 67566) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101018136) |
| 207L00000X Anesthesiology (Licence: TX U0054) | |
| 207L00000X Anesthesiology (Licence: IA DO-04398) | |
| 207L00000X Anesthesiology (Licence: NE COPS164) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2025-12-12 |