| NPI | 1073741153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2013-00962) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL trn-14880) |
| 208600000X Surgery (Licence: SC LL31888) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2013-09-23 |