| NPI | 1760563258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00019829) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 229942) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2008-07-21 |