| NPI | 1275845588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MI 4301097093) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301097093) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2015-10-22 |