| NPI | 1558317578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX G6376) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT G6376) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2009-03-05 |