| NPI | 1609881036 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR 16476) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 1260) | 
| 207L00000X Anesthesiology (Licence: ND 10096) | |
| 207L00000X Anesthesiology (Licence: AK 5697) | |
| 207L00000X Anesthesiology (Licence: AZ 3891) | |
| 207L00000X Anesthesiology (Licence: ID 0.198) | |
| 207L00000X Anesthesiology (Licence: WV 1499) | |
| 207L00000X Anesthesiology (Licence: MO DO 116462) | |
| Enumeration Date | 2006-07-31 | 
| Last Update Date | 2010-05-18 |