| NPI | 1770802183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61259426) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 15131) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2024-01-22 |