| NPI | 1760867261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 104807) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301108009) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2026-05-05 |