| NPI | 1548796923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101276443) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 62260) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101276443) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KY 62260) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2026-07-31 |