| NPI | 1316479637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 77524) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 287636) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-06-05 |