| NPI | 1811579444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX BP10075189) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX U9599) |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2024-03-25 |