| NPI | 1326807447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: 110510107011746) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KY 62372) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2026-07-30 |