| NPI | 1104386754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS19817) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO CDRH.0073038) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2026-04-22 |