| NPI | 1124134242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301053092) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI KM053092) |
| 174400000X Specialist (Licence: MI 4301053092) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2016-05-13 |