| NPI | 1184627564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60636225) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM 2003-0470) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2018-11-26 |