| NPI | 1629179965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101038880) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 46785) |
| 207L00000X Anesthesiology (Licence: FL ME96795) | |
| 207L00000X Anesthesiology (Licence: SC 92895) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2026-04-10 |