| NPI | 1316141989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX M9335) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP1-0017400) |
| 207L00000X Anesthesiology (Licence: TX M9335) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2018-02-22 |