| NPI | 1952696601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR DO192724) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102203407) |
| 208D00000X General Practice (Licence: VA 0102203407) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2019-06-13 |