| NPI | 1275913949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: RI MD17010) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT208966) |
| 207L00000X Anesthesiology (Licence: IA R-11403) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2020-06-29 |