| NPI | 1497289581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 430150413) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY C4731) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2025-10-29 |