| NPI | 1003857590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 219918) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 259903) |
| 207L00000X Anesthesiology (Licence: AZ 50540) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-05-24 |