| NPI | 1487647731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME79836) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX K8357) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2011-02-04 |