| NPI | 1770878308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC RTL21-0903) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS 010504) |
| 183500000X Pharmacist (Licence: TN 33571) | |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2021-06-10 |