| NPI | 1629285747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60217468) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 55906-020) |
| 207L00000X Anesthesiology (Licence: TN 53159) | |
| 207L00000X Anesthesiology (Licence: VA 0101242466) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2023-10-20 |