| NPI | 1861479974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 29753) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 47099) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2019-10-06 |