| NPI | 1962082198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 79170) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 82016-20) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-07-01 |