| NPI | 1407423783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 1027550) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 86199) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 1027550) | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2026-06-03 |