| NPI | 1861645624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 50238) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D80375) |
| 207L00000X Anesthesiology (Licence: NE 25332) | |
| 207L00000X Anesthesiology (Licence: VA 0101259908) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2022-07-21 |