| NPI | 1780664532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI ME145995) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 40164) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2021-06-30 |