| NPI | 1912988775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NV 1409) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV DO1409) |
| 208D00000X General Practice (Licence: NV 1409) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2023-06-29 |