| NPI | 1134562754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 55498) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 65470) |
| 207L00000X Anesthesiology (Licence: NM MD2016-0966) | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2019-05-15 |