| NPI | 1871818583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101250170) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101250170) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2022-12-23 |