| NPI | 1164632402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD435081) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301083141) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2020-10-09 |