| NPI | 1003298670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MT211937) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 298208) |
| 208600000X Surgery (Licence: AZ R75049) | |
| 207L00000X Anesthesiology (Licence: VT 042.0014635) | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2020-05-04 |