| NPI | 1366423691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: LA 07862R) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA L07862R) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2024-10-30 |