| NPI | 1578914065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2020011527) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NE 7784) |
| Enumeration Date | 2016-06-25 |
| Last Update Date | 2020-06-29 |