| NPI | 1710617170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 75359) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 32761) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-09-22 |