| NPI | 1417902313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 230405) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT 0420010760) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |