| NPI | 1407242720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61197274) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 18821) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2026-02-20 |