| NPI | 1851631667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 65254) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101256723) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2023-11-16 |