| NPI | 1073650511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MT 87866) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60072352) |
| 207L00000X Anesthesiology (Licence: MD D67552) | |
| 207L00000X Anesthesiology (Licence: MD T4905) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-10-13 |