| NPI | 1669009189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61530672) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 0067551) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-05-15 |