| NPI | 1720309420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C156219) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 54022-20) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: WI 54022-20) | |
| 207L00000X Anesthesiology (Licence: NY 258325) | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2019-08-13 |