| NPI | 1649295601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M2587) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 35031) |
| 207L00000X Anesthesiology (Licence: NY 218664) | |
| 207L00000X Anesthesiology (Licence: FL ME 90756) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-11-08 |