| NPI | 1043357452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2003022490) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: MO 2003022490) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-03-10 |