| NPI | 1184936882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 50188) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301096873) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2015-07-15 |