| NPI | 1619962735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO 24005) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 20158) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2012-08-10 |