| NPI | 1558943340 |
|---|---|
| Other Name | N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NV 28045) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 1558943340) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2025-09-03 |