| NPI | 1548655681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 63104) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO CDR.0006114) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-12-11 |