| NPI | 1720083124 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD459502) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA07313900) |
| 207L00000X Anesthesiology (Licence: AZ 34508) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2018-11-20 |