| NPI | 1063594513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D67510) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2006006311) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2015-09-01 |