| NPI | 1881915528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60860699) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301105633) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2019-03-21 |