| NPI | 1154308500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX G9889) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX G9889) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2019-08-29 |