| NPI | 1679612923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2010026214) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2008021947) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2021-03-08 |