| NPI | 1396096632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: ID 7971254) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OS022543) |
| 207L00000X Anesthesiology (Licence: KS 94-09638) | |
| 247200000X Technician, Other | |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2026-09-01 |