| NPI | 1912104274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D70762) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 208D00000X) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2022-12-07 |