| NPI | 1861648800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 61085) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2011-00740) |
| 207L00000X Anesthesiology (Licence: TX Q3019) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2019-10-11 |