| NPI | 1619466885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD494575) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041972) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2026-07-13 |