| NPI | 1588985790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 073860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 4143) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2015-09-02 |