| NPI | 1043251713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00037603) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD19822) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2025-05-07 |