| NPI | 1659359255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301085131) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY C4612) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2025-10-27 |