| NPI | 1811083215 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO 44882) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102201451) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-08-19 |