| NPI | 1972658482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ AZ30822) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 12686) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2016-11-16 |