| NPI | 1265665939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 3416) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL OS14615) |
| 208D00000X General Practice (Licence: CA 20A11448) | |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2018-07-10 |