| NPI | 1780207712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61561449) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R11840) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2025-07-24 |