| NPI | 1538653977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MT216661) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT216661) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2021-07-31 |