| NPI | 1043548746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO DO2010020887) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OTO12484) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2019-06-17 |