| NPI | 1821065616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 15662) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M4624) |
| 207L00000X Anesthesiology (Licence: LA 017365) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2012-06-13 |