| NPI | 1881755387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ND 19760) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WY 7118A) |
| 207L00000X Anesthesiology (Licence: SD 10216) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-06-08 |