| NPI | 1053712539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 55290) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 274276) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2023-08-24 |