| NPI | 1760680383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PR 18790) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: PR 18790) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2019-10-08 |