| NPI | 1861473720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MT 77789) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WY 11394A) |
| 207L00000X Anesthesiology (Licence: UT 1679831205) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-07-17 |