| NPI | 1477589299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 83982) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2014-01973) |
| 207L00000X Anesthesiology (Licence: WI 38434-20) | |
| 207L00000X Anesthesiology (Licence: IL 036-066067) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-01-19 |