| NPI | 1639348014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 201500496) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV SL0535) |
| 208D00000X General Practice (Licence: VA 0102202255) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2015-06-16 |