| NPI | 1629126727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2018-02562) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101240247) |
| 207L00000X Anesthesiology (Licence: DC MD038661) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-02-05 |