| NPI | 1023264918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 111111) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 947) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2024-01-16 |