| NPI | 1689783490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 33167) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 31313) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |