| NPI | 1508864851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ID M-6845) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 263133-1205) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2016-01-25 |