| NPI | 1770624397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00030284) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 77261) |
| 207L00000X Anesthesiology (Licence: LA MD0940212) | |
| 207L00000X Anesthesiology (Licence: LA M.D.09402R) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2014-02-14 |