| NPI | 1972864502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301100669) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 128257) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2021-11-17 |