| NPI | 1336123488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35 129372) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD428250) |
| 207L00000X Anesthesiology (Licence: TX L5629) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2017-06-07 |