| NPI | 1083925887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 51352) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD471930) |
| 207R00000X Internal Medicine (Licence: CT 51352) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2023-11-20 |