| NPI | 1528012630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 052712) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT 0420009089) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2014-12-03 |