| NPI | 1891955621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102202469) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL OS15920) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2020-02-25 |