| NPI | 1619970050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 69007) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM 2000-125) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-27 |