| NPI | 1497109466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 64887) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: RI DO01017) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2020-07-16 |