| NPI | 1780970525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME161461) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA MD-55085) |
| 207L00000X Anesthesiology (Licence: GA 9767) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2025-08-12 |