| NPI | 1164644464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 7650570-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR DO222362) |
| 207L00000X Anesthesiology (Licence: WI 3084-321) | |
| 207L00000X Anesthesiology (Licence: MT 148134) | |
| 207L00000X Anesthesiology (Licence: IA DO-07085) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-07-25 |