| NPI | 1104860675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 34182) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT 042-0010256) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-03-19 |