| NPI | 1245766641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 94482) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2016022714) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2025-07-02 |