| NPI | 1790198760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 86539) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206688) |
| 207L00000X Anesthesiology (Licence: MD D84708) | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2020-10-29 |