| NPI | 1912115692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 63580) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 4754) |
| 207L00000X Anesthesiology (Licence: VA 0102201925) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2010-07-06 |