| NPI | 1932193604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 272263-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101010132) |
| 207L00000X Anesthesiology (Licence: MS 15448) | |
| 207L00000X Anesthesiology (Licence: ID O-168) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2007-10-10 |