| NPI | 1609187087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2014011269) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2024-04-17 |