| NPI | 1104890532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 73531) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME160201) |
| 207L00000X Anesthesiology (Licence: NY 319551) | |
| 207L00000X Anesthesiology (Licence: AL 18720) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2025-11-17 |