| NPI | 1053304915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 14874) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO CDRH.0041226) |
| 207L00000X Anesthesiology (Licence: VA 0101284083) | |
| 207L00000X Anesthesiology (Licence: CO 41226) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2026-05-27 |