| NPI | 1356476410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: DC MD 6405) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: DC MD 6405) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |