| NPI | 1770569949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN MD20534) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 28187) |
| 207L00000X Anesthesiology (Licence: KY 36353) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2007-07-08 |