| NPI | 1770509622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2004-00901) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101-2290-28) |
| 207L00000X Anesthesiology (Licence: NM MD2006-0558) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-08-20 |