| NPI | 1336256619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 51894) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 39836-21) |
| 207L00000X Anesthesiology (Licence: MO 2013033409) | |
| 207L00000X Anesthesiology (Licence: MI 5101011439) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2018-03-17 |