| NPI | 1972942761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD198399) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60760983) |
| 207L00000X Anesthesiology (Licence: IL 125.063174) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2020-06-02 |