| NPI | 1538122601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301051435) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 157169) |
| 207L00000X Anesthesiology (Licence: NC 2026-03874) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2026-07-21 |