| NPI | 1770858615 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD223781) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A191721) | 
| Enumeration Date | 2012-03-10 | 
| Last Update Date | 2025-09-05 |