| NPI | 1508822263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M3625) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 46454) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2012-07-02 |