| NPI | 1225418452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 38220) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 274885) |
| 207Q00000X Family Medicine (Licence: SC MMD.38220 LL) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2020-09-18 |