| NPI | 1457610164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 52682) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73204) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2016-08-25 |