| NPI | 1104006451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD042449E) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301091181) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MI 4301091181) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: PA MD042449E) | |
| Enumeration Date | 2007-11-04 |
| Last Update Date | 2012-04-20 |