| NPI | 1619922663 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX L8570) | 
| Additional Taxonomies | 174400000X Specialist (Licence: TX L8570) | 
| Enumeration Date | 2006-05-24 | 
| Last Update Date | 2022-09-02 |