| NPI | 1821677881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U6538) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO DR.0076319) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-09-30 |