| NPI | 1962559070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 22154) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101056981) |
| 207L00000X Anesthesiology (Licence: SD 3841) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |