| NPI | 1083908867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology Critical Care Medicine (Licence: MA 258065) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 258065) |
| 207R00000X Internal Medicine (Licence: MA 248164) | |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2018-10-30 |