| NPI | 1184996530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301089888) |
| Additional Taxonomies | 282E00000X (Licence: MI 4301089888) |
| 282E00000X | |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-11-16 |