| NPI | 1285999623 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA GETP.201325) | 
| Additional Taxonomies | 208600000X Surgery (Licence: MS 825-L) | 
| Enumeration Date | 2012-07-11 | 
| Last Update Date | 2018-04-26 |