| NPI | 1336415561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 138072) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9283064) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2022-05-18 |