| NPI | 1194701078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 65222) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD26027) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-07-15 |