| NPI | 1558900712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OT024096) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102206795) |
| 208D00000X General Practice (Licence: VA 0102206795) | |
| Enumeration Date | 2020-01-04 |
| Last Update Date | 2025-05-13 |