| NPI | 1770590820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A85262) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60058186) |
| 207L00000X Anesthesiology (Licence: NC 2017-01866) | |
| 207L00000X Anesthesiology (Licence: TX R7527) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-08-15 |