| NPI | 1366412462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101050557) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 34938) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-09 |