| NPI | 1114048014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M5615) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX M5615) |
| 207L00000X Anesthesiology (Licence: TX M5616) | |
| 207P00000X Emergency Medicine (Licence: TX M5616) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2014-12-17 |