| NPI | 1013250315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 274387) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MA 274387) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2018-05-21 |