| NPI | 1952394694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 62802) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 3544) |
| 207L00000X Anesthesiology (Licence: IA 02465) | |
| 207Q00000X Family Medicine (Licence: IA 02465) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2020-05-21 |