| NPI | 1205003001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 37880) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN12469) |
| 207L00000X Anesthesiology (Licence: FL ME113040) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2016-03-04 |