| NPI | 1164697793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101247315) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 128067) |
| 207L00000X Anesthesiology (Licence: MD D69172) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2011-02-15 |