| NPI | 1689655995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: WI 44836) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44836) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2013-07-16 |