| NPI | 1346513587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 71519) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101048032) |
| 207Q00000X Family Medicine (Licence: VA 0101048032) | |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2020-05-05 |