| NPI | 1851386205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 19613) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: NC 200100339) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2012-01-23 |