| NPI | 1619914827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 53813) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO 38617) |
| 207Q00000X Family Medicine (Licence: CO 38617) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2015-03-30 |