| NPI | 1679049019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA 9098) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 009098) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2022-09-03 |