| NPI | 1275602740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 4990) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND 10608) |
| 207L00000X Anesthesiology (Licence: MT 160706) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2021-01-15 |