| NPI | 1124019161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 47111) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX E2578) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2013-10-28 |