| NPI | 1205906674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M6129) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 48202) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2010-07-22 |