| NPI | 1578026233 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS023159) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL OS22158) | 
| Enumeration Date | 2019-04-10 | 
| Last Update Date | 2025-05-23 |