| NPI | 1265646707 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: DC MD038468)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101246711)  | 
| 207L00000X Anesthesiology (Licence: MD D70033)  | |
| Enumeration Date | 2007-05-10 | 
| Last Update Date | 2013-12-02 |