| NPI | 1407173990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 55585) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD 77162) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2026-04-17 |