| NPI | 1336433507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR DO201761) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 943) |
| 207L00000X Anesthesiology (Licence: CA 20A17688) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-03-02 |