| NPI | 1740500610 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2010017988)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2010017988)  | 
| Enumeration Date | 2010-06-02 | 
| Last Update Date | 2019-03-19 |