| NPI | 1982054573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY 14040A) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 56972) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2021-11-18 |