| NPI | 1578707717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SD 2823) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 104994) |
| 207L00000X Anesthesiology (Licence: MN 53391) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2013-06-19 |