| NPI | 1285669010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 21568) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA G075848) |
| 207L00000X Anesthesiology (Licence: NY 170999) | |
| 207L00000X Anesthesiology (Licence: MI 4301084679) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |