| NPI | 1598064776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO 56848) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.059858) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2016-07-06 |