| NPI | 1922002609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 28486) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA 40354) |
| 207L00000X Anesthesiology (Licence: MN 52942) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2014-08-12 |