| NPI | 1972591733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0029916) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NE 26009) |
| 207L00000X Anesthesiology (Licence: TX F5473) | |
| 207L00000X Anesthesiology (Licence: WY TL#1443) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2013-06-06 |