| NPI | 1083039341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 20293) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 20293) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2014-02-24 |