| NPI | 1205032869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA MD.204785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI MDR-5243) |
| 207L00000X Anesthesiology (Licence: MA 235848) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2014-04-22 |