| NPI | 1053798397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301515564) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2020032283) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2026-03-25 |