| NPI | 1154513596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD177425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT190332) |
| 207L00000X Anesthesiology (Licence: NH 15316) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2023-07-24 |