| NPI | 1629208145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 26003) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301094899) |
| 208D00000X General Practice (Licence: IN 01068393A) | |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2018-02-23 |