| NPI | 1689667420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0045552) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 02628) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2017-02-10 |