| NPI | 1366551178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN187) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 43273) |
| 207L00000X Anesthesiology (Licence: FL ACN187) | |
| 208D00000X General Practice (Licence: MN 43273) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2009-05-29 |