| NPI | 1104495548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2024015147) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MO 2024015147) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2026-09-01 |