| NPI | 1689069817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 278066) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 266456) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2019-07-12 |