| NPI | 1518265982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2014006543) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 5031) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2015-04-21 |