| NPI | 1013204791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MT206634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS T-2400) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2017-05-09 |