| NPI | 1871613067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2009008008) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 04-27499) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-06-03 |