| NPI | 1780661058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 80026) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 223163) |
| 207L00000X Anesthesiology (Licence: NH 21382) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2026-06-26 |