| NPI | 1467635672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 068955) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2010-00533) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2015-02-02 |