| NPI | 1982081675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD.MD.61132817) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD194239) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2021-07-15 |