| NPI | 1457407983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME161539) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MI 4301085116) |
| 207L00000X Anesthesiology (Licence: WI 85789) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-07-25 |