| NPI | 1063707214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA MD-42430) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6508) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2015-06-08 |