| NPI | 1275996340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 68497) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD486716) |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2026-06-11 |