| NPI | 1972791705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0067523) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA 99999999) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2022-04-08 |