| NPI | 1184775629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00014592) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 21658) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2007-10-18 |