| NPI | 1497962690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101239222) |
| Additional Taxonomies | 202K00000X (Licence: VA 0101239222) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-04-23 |