| NPI | 1205154622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102203704) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 3042) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2021-03-26 |