| NPI | 1912169574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 57481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125055003) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-09-16 |