| NPI | 1346452885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60126315) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301088537) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-01-31 |