| NPI | 1457694234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60744867) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA ML60376219) |
| Enumeration Date | 2013-03-31 |
| Last Update Date | 2018-03-17 |