| NPI | 1063153609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301514630) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 4301514630) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2026-07-13 |