| NPI | 1619396397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS16542) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 101995-875) |
| 207L00000X Anesthesiology (Licence: NY 295817) | |
| 207L00000X Anesthesiology (Licence: GA 83639) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2026-07-30 |