| NPI | 1760685978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 58636) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME 97400) |
| 207L00000X Anesthesiology (Licence: TN MD 41611) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 58636) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2013-09-17 |