| NPI | 1104323997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2022-00657) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 91310) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-04-04 |