| NPI | 1366452641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD467562) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101231203) |
| 174400000X Specialist (Licence: VA 0101231203) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2019-08-12 |