| NPI | 1164854659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 30661) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 256349) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2018-07-03 |