| NPI | 1972661296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD33166) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM MD2006-0737) |
| 207L00000X Anesthesiology (Licence: CO 45127) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2010-10-06 |