| NPI | 1285758060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301039564) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301039564) |
| 208D00000X General Practice (Licence: MI 4301039564) | |
| 209800000X Legal Medicine (Licence: MI 4301039564) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |