| NPI | 1033590096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 34470) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 59451) |
| 207L00000X Anesthesiology (Licence: WA 61002525) | |
| 207L00000X Anesthesiology (Licence: NE 7482) | |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-07-19 |