| NPI | 1265790018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0062807) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60675940) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2021-05-12 |