| NPI | 1396883740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0056625) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2006-01351) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-07-08 |