| NPI | 1679137921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101277564) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2022-01273) |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2023-05-31 |