| NPI | 1679181622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042.0018299) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 285479) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-07-22 |