| NPI | 1295116135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61056326) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2017021297) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2021-08-30 |