| NPI | 1669463139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 33889) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 63554) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2022-01-12 |