| NPI | 1104912450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301051728) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301051728) |
| 207P00000X Emergency Medicine (Licence: MI 4301051728) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2009-01-05 |