| NPI | 1164155867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology Critical Care Medicine (Licence: GA 11272) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 11272) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-12-15 |