| NPI | 1619137890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD H0072162) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT012048) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2012-04-18 |