| NPI | 1609873264 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 21323) | 
| Additional Taxonomies | 174400000X Specialist (Licence: TN 021323) | 
| Enumeration Date | 2005-06-28 | 
| Last Update Date | 2008-08-20 |