| NPI | 1063496990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 230882) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 039981) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2024-11-12 |