| NPI | 1154886182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101270839) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101270839) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2025-08-12 |