| NPI | 1790772564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00040751) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD25808) |
| 174400000X Specialist | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2009-04-02 |