| NPI | 1295819779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME108910) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 28926) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-02-24 |