| NPI | 1770566291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD464805) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D0060159) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2019-10-14 |