| NPI | 1275199119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102206816) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2024-02595) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2026-01-28 |