| NPI | 1679837595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 36104) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 5461) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2022-07-21 |