| NPI | 1659639409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0067566) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 99579) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2022-02-16 |