| NPI | 1790755130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 44946) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME103304) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2020-08-03 |