| NPI | 1760433098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 56749) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 60074) |
| 207L00000X Anesthesiology (Licence: TX J8572) | |
| 207L00000X Anesthesiology (Licence: ME MD22759) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2025-12-10 |