| NPI | 1730863663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301512523) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301512523) |
| 208D00000X General Practice (Licence: MI 4301512523) | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-08-07 |