| NPI | 1578653143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 75220) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AR R-4501) |
| 208D00000X General Practice (Licence: GA 75220) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-09-12 |