| NPI | 1124257191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD457830) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA mt194421) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2025-09-15 |