| NPI | 1134313307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME109248) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2007015197) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2012-11-13 |