| NPI | 1487812251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 9489511-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO 51204) |
| 207L00000X Anesthesiology (Licence: VT 060.0003666) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2018-02-28 |