| NPI | 1568781144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MS 19115) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 39484) |
| 207L00000X Anesthesiology (Licence: PA MD439902) | |
| Enumeration Date | 2010-05-22 |
| Last Update Date | 2011-07-29 |