| NPI | 1912231903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD451107) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 254654) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2021-03-01 |