| NPI | 1104856749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 18914) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: OK 18914) |
| 208D00000X General Practice (Licence: OK 18914) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: OK 18914) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-10-22 |