| NPI | 1902120645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD170937) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 56079-020) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2015-04-10 |