| NPI | 1750947552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U4306) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101025870) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2025-09-26 |