| NPI | 1699095554 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2012-01421) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 164525) | 
| Enumeration Date | 2010-06-02 | 
| Last Update Date | 2018-08-07 |