| NPI | 1780996975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 49271) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301096911) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2014-08-20 |