| NPI | 1225579014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101265140) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2021-03054) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2024-05-29 |