| NPI | 1114907169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M5319) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GU M001440) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2008-11-10 |