| NPI | 1164868022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2021000376) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101020495) |
| 207L00000X Anesthesiology (Licence: CO DR.0060139) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2024-05-29 |