| NPI | 1083750509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 006358) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200300978) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2014-12-04 |