| NPI | 1285610170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 2202) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 2202) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2025-12-16 |