| NPI | 1093204174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 165371) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 65774) |
| 207R00000X Internal Medicine (Licence: AZ R76655) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2025-10-03 |