| NPI | 1659582310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA 39513) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ R70552) |
| 207L00000X Anesthesiology (Licence: NE 25820) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2011-07-01 |