| NPI | 1891717096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2007-00270) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L9118) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-02-02 |