| NPI | 1184874513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX G3623) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX G3623) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2019-06-07 |