| NPI | 1932630803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD473739) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT212967) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-05-03 |