| NPI | 1538574074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A161288) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 6827) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2019-07-31 |