| NPI | 1528488632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61165854) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: WA MD61165854) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2022-11-15 |