| NPI | 1386783215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 23533) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200401329) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-04-07 |