| NPI | 1235329418 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 154325)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD157467)  | 
| 207L00000X Anesthesiology (Licence: WA ML20008886)  | |
| Enumeration Date | 2007-07-25 | 
| Last Update Date | 2018-05-30 |