| NPI | 1710206578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61045317) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT199396) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2023-10-06 |