| NPI | 1619942455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN MD24452) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA MD33595) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2007-07-08 |