| NPI | 1932755543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 72599) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT217872) |
| Enumeration Date | 2019-08-11 |
| Last Update Date | 2023-10-05 |