| NPI | 1801942586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO 47959) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 7008007-1205) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2017-02-16 |