| NPI | 1396165445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL me137154) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA 311124) |
| 207L00000X Anesthesiology (Licence: WV 29515) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-09-26 |