| NPI | 1518250117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 073728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199341) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2022-04-13 |