| NPI | 1831619287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61283056) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2017019527) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2022-08-01 |