| NPI | 1215913611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA MD.201152) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A90433) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-08-07 |