| NPI | 1295890754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 241805) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 225687) |
| 207L00000X Anesthesiology (Licence: MA 2418052) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2015-11-16 |