| NPI | 1124413059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS019872) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT016430) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2019-06-20 |