| NPI | 1093782955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2009-01922) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101268133) |
| 207L00000X Anesthesiology (Licence: SC 52400) | |
| 207L00000X Anesthesiology (Licence: GA 88020) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2026-04-02 |