| NPI | 1912365024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 30529) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD61448867) |
| 208D00000X General Practice (Licence: NE 30529) | |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2024-05-30 |