| NPI | 1922235167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO CDRH.0053704) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM MD2019-0203) |
| 207L00000X Anesthesiology (Licence: NH 19624) | |
| 207L00000X Anesthesiology (Licence: ME MD23081) | |
| 207L00000X Anesthesiology (Licence: TN 62350) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2023-09-14 |