| NPI | 1225410640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 273436) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 264275) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-06-06 |