| NPI | 1174518674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 34153) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 010-105-8083) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2020-11-11 |