| NPI | 1639292329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2010042350) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 04-34107) |
| 208D00000X General Practice (Licence: TX M5909) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2019-06-04 |