| NPI | 1629261136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101253152) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN none) |
| 207L00000X Anesthesiology (Licence: GA 066432) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2014-03-05 |