| NPI | 1770901803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 63422) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 65345-20) |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2018-07-18 |