| NPI | 1023060399 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA 44987) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 112687) | 
| Enumeration Date | 2006-05-16 | 
| Last Update Date | 2024-12-02 |