| NPI | 1598964603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD480482) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2017030006) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0101244048) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2024-02-13 |