| NPI | 1750492559 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR or md22748)  | 
| Additional Taxonomies | 208VP0000X  (Licence: OR or md22748)  | 
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2007-07-12 |