| NPI | 1720055494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101057305) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD060174L) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2019-01-14 |