| NPI | 1912361395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 54251) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 54251) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2021-06-03 |