| NPI | 1457342578 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NH 13510) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 52823) | 
| Enumeration Date | 2005-10-31 | 
| Last Update Date | 2013-07-17 |