| NPI | 1336631308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 70638) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04281) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2023-11-08 |