| NPI | 1972593754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MT MED-PHYS-LIC-10277) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD069096L) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2013-08-07 |