| NPI | 1326133042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA G69085) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY C5131) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KY C5131) | |
| 207L00000X Anesthesiology (Licence: IA MD-56283) | |
| 207L00000X Anesthesiology (Licence: ME MD29107) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-03-03 |