| NPI | 1962774075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO 35842) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 35842) |
| Enumeration Date | 2012-02-04 |
| Last Update Date | 2012-03-02 |