| NPI | 1154531366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ND 11071) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5315022952) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-03-25 |