| NPI | 1215566492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 1215566492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 207R00000X) |
| 207L00000X Anesthesiology (Licence: WI 81845) | |
| 207L00000X Anesthesiology (Licence: PA OS025269) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-02-23 |