| NPI | 1700872629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101282128) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 53161) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2025-01-05 |