| NPI | 1750562799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: LA 201046) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX 201046) |
| 207RB0002X Internal Medicine Obesity Medicine (Licence: TX 201046) | |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2023-05-10 |