| NPI | 1376518209 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN MD13859) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA MD28260) | 
| Enumeration Date | 2006-02-22 | 
| Last Update Date | 2013-09-17 |