| NPI | 1689644551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101286551) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 13318) |
| 207L00000X Anesthesiology (Licence: CO 32183) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2025-08-15 |