| NPI | 1255429510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A100599) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 2385861) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-06-11 |