| NPI | 1689782559 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 37085) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 24336) | 
| Enumeration Date | 2006-08-29 | 
| Last Update Date | 2018-03-17 |