| NPI | 1659597920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 11740) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 946565) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |