| NPI | 1841710902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 87406) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 68658) |
| 207L00000X Anesthesiology (Licence: MO 2019017103) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2026-06-22 |