| NPI | 1487807335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 060761) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: GA 060761) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2008-10-23 |