| NPI | 1982711248 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 45793) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101014790) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-12-03 |