| NPI | 1194087130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61059744) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101254540) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2020-06-18 |