| NPI | 1376074583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101265211) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101265211) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2025-07-30 |