| NPI | 1972724680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 64824) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2011-00686) |
| 207L00000X Anesthesiology (Licence: SC MD40809) | |
| 207L00000X Anesthesiology (Licence: KY 45169) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2022-06-27 |