| NPI | 1568715258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 281899) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60279123) |
| 207L00000X Anesthesiology (Licence: NY 292332) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2020-04-25 |