| NPI | 1477915874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1013074) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: RI MD19120) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2024-09-13 |