| NPI | 1851613590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 076805) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R71433) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2016-11-03 |