| NPI | 1619089778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR OR MD16228) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA WA MD00034710) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |