| NPI | 1811983513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD073094L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 239566) |
| 207L00000X Anesthesiology (Licence: IA 35358) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2018-04-20 |