| NPI | 1114129103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ND 12439) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2004012111) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2014-05-28 |