| NPI | 1770796716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 006090) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2006-01417) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2015-09-08 |