| NPI | 1679622336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME65273) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me0065273) |
| 207L00000X Anesthesiology (Licence: NV 16231) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2015-12-21 |