| NPI | 1326337916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61152203) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM MD2015-0545) |
| 207L00000X Anesthesiology (Licence: AL 34970) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-09-21 |