| NPI | 1639589625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 293170) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 60474848) |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2020-08-12 |