| NPI | 1639266455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP60006008) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2005020367) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-12-07 |