| NPI | 1487880415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 47639) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-R-8652) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2013-06-25 |