| NPI | 1083005417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S7706) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AR E-16955) |
| 208D00000X General Practice (Licence: NE 29770) | |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2023-08-10 |