| NPI | 1205907607 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX W1302)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101011085)  | 
| 207L00000X Anesthesiology (Licence: ME DO4010)  | |
| 207L00000X Anesthesiology (Licence: WI 81263)  | |
| Enumeration Date | 2006-11-10 | 
| Last Update Date | 2025-10-03 |