| NPI | 1124016530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 48440) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102201495) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2011-12-06 |