| NPI | 1215955885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA 60771584) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD14891) |
| 207L00000X Anesthesiology (Licence: WY TL1962) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-05-15 |