| NPI | 1417225681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP60551811) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL OS15641) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2025-09-30 |