| NPI | 1457302358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 47390) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA MD-55576) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-11-25 |