| NPI | 1255793097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA 61013306) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068923) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2020-04-08 |