| NPI | 1609809995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 27387) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND 10242) |
| 207L00000X Anesthesiology (Licence: PA MD430541) | |
| 207L00000X Anesthesiology (Licence: KY 41645) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2011-04-15 |