| NPI | 1700873742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS006143L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL OS7545) |
| 207L00000X Anesthesiology (Licence: NJ 25MB05619400) | |
| 207L00000X Anesthesiology (Licence: DE C2-0007023) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2019-10-23 |