| NPI | 1881758019 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 33689)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2017-01235)  | 
| Enumeration Date | 2006-12-21 | 
| Last Update Date | 2021-02-26 |