| 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 |