| NPI | 1528709474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4351049423) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2026-04255) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-08-21 |