| NPI | 1720468515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S4553) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 278153) |
| 208600000X Surgery (Licence: MA 263655) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-09-08 |