| NPI | 1033503412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 63020) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 66336) |
| 208D00000X General Practice (Licence: WI 66336-20) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2021-08-12 |