| NPI | 1811952385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2003015259) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2003015259) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2013-03-26 |