| NPI | 1699160838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0062678) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 60643) |
| 208D00000X General Practice (Licence: MI 4301107277) | |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2019-06-05 |