| NPI | 1710500855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MN 75938) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4351046621) |
| Enumeration Date | 2020-05-23 |
| Last Update Date | 2024-06-14 |