| NPI | 1003179961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101287682) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC LL34900) |
| 207L00000X Anesthesiology (Licence: KY 49242) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2025-11-28 |