| NPI | 1659013605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA DO.OP.70090786) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MI 5101028632) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2026-07-20 |