| NPI | 1790990752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 4805) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA OP60155531) |
| 207L00000X Anesthesiology (Licence: NV DO1412) | |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2022-07-05 |