| NPI | 1568775310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 48055) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 244954) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2015-06-09 |