| NPI | 1912104258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD439468) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 23102) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2014-11-26 |