| NPI | 1003494477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD490907) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2026-02696) |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-06-30 |