| NPI | 1790275170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 276033) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 276033) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2024-05-30 |