| NPI | 1033645346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD.MD.70098901) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57.249277) |
| 207L00000X Anesthesiology (Licence: OR MD220840) | |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2026-07-07 |