| NPI | 1063202604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4351054532) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351054532) |
| Enumeration Date | 2025-05-07 |
| Last Update Date | 2026-04-27 |