| NPI | 1124099437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA 60187979) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 16236) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2012-09-06 |