| NPI | 1174509962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ME 016146) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2014-00808) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2016-07-26 |