| NPI | 1831396902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME108762) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL30118) |
| 207L00000X Anesthesiology (Licence: FL TRN12109) | |
| 207L00000X Anesthesiology (Licence: WA MD60207185) | |
| Enumeration Date | 2007-06-30 |
| Last Update Date | 2015-09-21 |