| NPI | 1124050026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 200400353) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NC 2004-00353) |
| 207Q00000X Family Medicine (Licence: NC 200400353) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-08-31 |