| NPI | 1114155264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301094411) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301094411) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2014-07-03 |