| NPI | 1366860983 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 57526) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 71905) |
| 207L00000X Anesthesiology (Licence: NC 2023-00177) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2025-02-04 |