| NPI | 1578693651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00031593) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD428509) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2015-03-06 |