| NPI | 1710544754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61680271) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA MD-51545) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2025-05-27 |