| NPI | 1942646211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 60942) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R74012) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2021-01-15 |