| NPI | 1801086756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 54855) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 67919) |
| 207L00000X Anesthesiology (Licence: MI L1150965) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2023-07-12 |