| NPI | 1245248301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX E5290) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A29671) |
| 207L00000X Anesthesiology (Licence: MO 35457) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |