| NPI | 1962470419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101044999) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101044999) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2012-03-29 |