| NPI | 1750151056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA 61516359) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA AP61516359) |
| 207L00000X Anesthesiology (Licence: WA AP61516359) | |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2025-11-26 |