| NPI | 1487916151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 269785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73458) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2022-07-21 |