| NPI | 1528417086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V2599) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2016018214) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2026-06-23 |