| NPI | 1508921651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO MDR8G40) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MO R8G40) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2015-11-20 |