| NPI | 1710386784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AR T2020-031) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301104411) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2020-04-09 |