| NPI | 1942306220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME118574) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 870911-1105) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: AZ 35931) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2014-12-17 |