| NPI | 1174796585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301100037) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 36682) |
| 207L00000X Anesthesiology (Licence: NC RTL) | |
| 207L00000X Anesthesiology (Licence: PA MD444777) | |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2016-09-13 |