| NPI | 1487635785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101236533) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 26794) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2021-03-24 |