| NPI | 1932369634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ND 12395) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO MT192932) |
| 207L00000X Anesthesiology (Licence: MN 52241) | |
| 207L00000X Anesthesiology (Licence: MN 104453) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2019-09-10 |