| NPI | 1063904126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD220078) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA R-11283) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2024-08-06 |