| NPI | 1609121623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 66051) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA BM6733807-Q142) |
| 208600000X Surgery (Licence: MI 4301100889) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2019-08-05 |