| NPI | 1174887319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MS 23933) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD483174) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2026-03-05 |