| NPI | 1003831942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 11067R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 11067r) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2013-03-11 |