| NPI | 1114944741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60974769) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2005004445) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-01-04 |