| NPI | 1336450188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2010017083) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD453834) |
| Enumeration Date | 2010-06-27 |
| Last Update Date | 2025-09-29 |