| NPI | 1356875777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61202822) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101266576) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2024-02-19 |