| NPI | 1477945939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 02268) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204729) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2022-10-20 |