| NPI | 1497743033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005477L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO 45281) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2018-07-09 |