| NPI | 1629029392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO ME37096) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT 042-0012161) |
| 207L00000X Anesthesiology (Licence: WA 00034096) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2012-06-15 |