| NPI | 1912937335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301077905) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI GP077905) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-06-30 |