| NPI | 1558718734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2023028749) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301501940) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2026-04-13 |