| NPI | 1710635800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA LT000987) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 2113) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2023-10-11 |