| NPI | 1063504504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 151518) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M4005) |
| 207L00000X Anesthesiology (Licence: NV 14594) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2017-09-28 |