| NPI | 1609491364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61687545) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC LL83141) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2025-05-27 |