| NPI | 1376924977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60922008) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA R-10342) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2019-06-27 |