| NPI | 1053392779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME117367) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301081167) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2025-07-15 |