| NPI | 1700453230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2025-00970) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 12880) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-07-11 |