| NPI | 1114121472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME98899) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 37025) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2012-01-30 |