| NPI | 1659345080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 71453) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 46750) |
| 207L00000X Anesthesiology (Licence: CO 0055601) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2021-01-19 |