| NPI | 1053354787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI AG082782) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI AG082782) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-04-13 |