| NPI | 1174511711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 25996) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO 43612) |
| 207L00000X Anesthesiology (Licence: WY 7824A) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2012-09-05 |