| NPI | 1962449090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00035720) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD25812) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2024-08-29 |