| NPI | 1538154802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101261925) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301056081) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2022-08-21 |