| NPI | 1194722785 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD22253) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 18016) | 
| Enumeration Date | 2005-06-28 | 
| Last Update Date | 2012-09-18 |