| NPI | 1356360986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX F9713) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME 50041) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME50041) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-10-01 |