| NPI | 1366440380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AR C2686) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AR C2686) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2008-10-02 |