| NPI | 1134395650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 54287) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP1-0031952) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2025-05-28 |