| NPI | 1770036410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC MMD.39925.LL) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 39925) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: SC 39925) | |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: SC 39925) | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2025-06-23 |