| NPI | 1770809477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301503892) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY C4747) |
| 207L00000X Anesthesiology (Licence: WI 64291) | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2026-04-22 |