| NPI | 1629539440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD70014476) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 13434432-1205) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-10-03 |