| NPI | 1760845580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO CDR.0003046) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX R7338) |
| 207L00000X Anesthesiology (Licence: VA 0101263129) | |
| 208D00000X General Practice (Licence: VA 0101263129) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2024-05-01 |