| NPI | 1265649115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 52255) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 242564) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2026-06-08 |