| NPI | 1528680188 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 75460) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R78155) | 
| Enumeration Date | 2020-05-17 | 
| Last Update Date | 2025-07-29 |