| NPI | 1912290073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101265156) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 255740) |
| 207LC0200X Anesthesiology Critical Care Medicine (Licence: VA 0101265156) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2023-09-01 |