| NPI | 1154852754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD203227) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 10955746-1205) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2021-06-29 |