| NPI | 1538505409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME133061) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R73780) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2018-08-16 |