| NPI | 1780204099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 5151014271) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101028086) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2024-06-20 |