| NPI | 1124147566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IL 036-104566) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: IL 036-104566) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2021-05-04 |