| NPI | 1619961398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD151763) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60726694) |
| 207L00000X Anesthesiology (Licence: UT 4739026-1205) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2021-04-01 |