| NPI | 1639352628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101252949) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT189075) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2012-12-06 |