| NPI | 1083864904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY 4341A) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: WY 4131A) |
| Enumeration Date | 2008-09-27 |
| Last Update Date | 2008-09-27 |