| NPI | 1972925113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101265775) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2013020684) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2024-10-21 |