| NPI | 1730863663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301512523) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301512523) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-07-31 |