| NPI | 1013399955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V3024) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101268206) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2025-05-28 |