| NPI | 1972693935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD218382) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 100928) |
| 207L00000X Anesthesiology (Licence: WA MD 00039823) | |
| 174400000X Specialist (Licence: WA MD00039823) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-11-26 |