| NPI | 1588621965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MS 08404) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MS 08404) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2016-02-24 |