| NPI | 1194708479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 44436) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5561) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2014-04-23 |