| NPI | 1619950904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 58806) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME90751) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2010-06-16 |