| NPI | 1720614647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 78884) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 80303773) |
| 207L00000X Anesthesiology (Licence: WI 83856) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-04-25 |