| NPI | 1588923544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AR E-13779) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP10046761) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 12-161) | |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2021-03-01 |