| NPI | 1770141483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD221198) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL82566) |
| 208D00000X General Practice (Licence: SC 82556) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2026-07-30 |