| NPI | 1770100802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301511534) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2020018992) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2024-11-14 |