| NPI | 1770802902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 65767) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101251279) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2019-07-01 |