| NPI | 1346504354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-00728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 5488) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2017-05-03 |