| NPI | 1609215359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD187164) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301102894) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2023-10-31 |