| NPI | 1679791545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD 60447551) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 43405) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2016-01-13 |