| NPI | 1376780247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CA A131662) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: RI MD15609) |
| 207Q00000X Family Medicine (Licence: NH 15259) | |
| 208600000X Surgery (Licence: CT 049698) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2022-06-23 |