| NPI | 1962865691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 326872) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AR E-13627) |
| 207L00000X Anesthesiology (Licence: SC 85513) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2023-10-05 |