| NPI | 1588695001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M2975) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MD H0058103) |
| 207L00000X Anesthesiology (Licence: FL OS11677) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2015-10-27 |