| NPI | 1679888663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS12545) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL UO2472) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2015-01-07 |