| NPI | 1265414528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: GA 050477) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0062915) |
| 207L00000X Anesthesiology (Licence: GA 050477) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2020-01-15 |