| NPI | 1003159096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60821188) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD175844) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2022-02-04 |